Light diffuser and process for producing the same

ABSTRACT

A light diffuser ( 10 ), which is particularly suitable for introducing diffuse light into a tissue, is produced by interpenetration of a diffuser material in a liquid state into a boundary layer ( 4 ) of a porous shaping material, by which process a diffuser surface is formed having a surface structure which represents essentially a negative of the pore structure of the shaping material and includes undercut structures induced by a surface tension. The light diffuser ( 10 ) is e.g. produced by introducing a diffuser blank ( 1 ) including material which is liquefiable through mechanical vibration into the shaping material and simultaneously stimulating it with mechanical vibrations, such that the liquefiable material liquefies at least there where it is in contact with the shaping material and is pressed into the shaping material. An in situ production of the diffuser is particularly advantageous for photodynamic therapy in bone tissue ( 20 ).

This application is a continuation in part of U.S. application Ser. No.11/568,553, filed on Dec. 6, 2006 and is currently pending and which isa national stage filing of PCT/CH2005/000246, filed on May 3, 2005 whichclaims priority to Swiss Patent 778/04, filed on May 3, 2004.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention concerns a light diffuser according to the generic term ofthe first independent claim, as well as a method for producing the lightdiffuser according to the generic term of the corresponding independentclaim. The light diffuser according to the invention is suitable for thediffuse deflection of light delivered to the diffuser from a lightsource or through a light conductor in an essentially axial direction.The light diffuser according to the invention is e.g. suitable forapplication in endoscopic methods, e.g. for the targeted introduction ofdiffuse light into tissue structures, in particular into bone tissue,and for the consistent illumination of hollow biological structures.

2. Description of Related Art

Diffuse light is applied in tissue structures e.g. in the so-calledphotodynamic therapy methods known in particular for the treatment oftumorigenic diseases. For this purpose a substance, which is sensitiveto light and accumulates mainly in the tumorous tissue, is administeredto a patient. Then the tumorous tissue is illuminated with light of aspecific wavelength, which activates the photosensitive substance andtriggers a chemical reaction, which in turn destroys the tumorous cells.

Activating the photosensitive substance by light initiates thedestruction of the tumorous cells. It is therefore important to be ableto introduce a specific dose of light adjusted to the size of the tumourin a targeted manner and as homogenously as possible into the tumoroustissue, which is usually achieved by means of a light conductor, whereinthe distal end of the light conductor is designed as a diffuser. Thetask of the diffuser is to scatter the light, which propagatesessentially axially inside the light conductor, in as many differentdirections as possible and as evenly as possible. The diffuser isbrought to, or introduced into the tissue to be illuminated and issupplied by the light conductor with light of a given wavelength. Thediffuser distributes the light introduced by the light conductor ashomogenously as possible in a space whose shape is advantageouslyadapted to the circumstances.

Such diffusers are known to be manufactured by correspondingmodification of the distal end of a light conductor and/or by placing anappropriately equipped end-piece on or at the distal end of the lightconductor. Thus e.g. the sleeve placed around the light conducting fibreis removed at the distal end of the light conductor and the surface ofthe light conducting fibre is roughened slightly, etched or treated withsuitable tools to create a light scattering surface, as it is disclosede.g. in the publication FR-2782778. Light scattering end-pieces usuallycomprise a transparent material filled with particles (e.g. transparentplastics with particles of aluminium oxide or titanium oxide). In casethe light scattering effect of the modified fibre surface and/or of theend piece does not suffice to deflect an adequate portion of thesupplied light from the axial direction, it is also suggested that amirror is positioned at the distal end of the light conductor or of thediffuser, reflecting non-deflected light back into the diffuser area(e.g. disclosed in U.S. Pat. No. 5,695,583, US-2002/0094161 and U.S.Pat. No. 5,431,647).

Known light diffusers, thus, essentially represent the distal end of alight conductor and for medical purposes are brought to, or introducedinto the tissue to be treated with minimally invasive methods andremoved after the treatment. For the treatment, the proximal end of thelight conductor is attached to a light source, wherein the light sourceis e.g. a laser, but can also be the distal end of another lightconductor.

The known diffusers described above are manufactured by relativelyelaborate methods and are therefore expensive. They nevertheless have tobe treated as disposable items as they are difficult to clean andsterilize and the risk of infection is clinically often considered toohigh for a repeated application. For photo-dynamic therapy, the diffuserhas to be brought into the immediate vicinity of, or even into thetissue to be treated and it has to be retracted from this tissue afterthe treatment, which is connected with the danger of diseased cells,e.g. metastasizing tumorous cells, being spread.

BRIEF SUMMARY OF THE INVENTION

The object of the invention is to create a light diffuser as well as amethod for producing the same. The light diffuser according to theinvention is to be suitable for most diverse applications, not onlymedical but also technical applications, in particular however for theaforementioned introduction of diffuse light into bone tissue(photodynamic therapy) and for the homogenous illumination of hollowbiological structures (hollow organs). Compared to the production ofknown light diffusers, the method for producing the light diffuseraccording to the invention is to be simpler and it is to enable a simpleadjustment to given circumstances, of the geometry of the space to beprovided with diffuse light.

This object is achieved by the light diffuser and the method for itsproduction as defined in the claims.

The method according to the invention, serving for producing a lightdiffuser, or for supplying diffuse light to tissue, in particular tobone tissue respectively, is based on the following finding: When animplant consisting of a thermoplastic material is implanted in bonetissue by means of mechanical oscillation, in particular ultrasound, asdescribed e.g. in the publication WO-02/069817, its surface changes inparticular where this surface is, or is brought into contact with thebone tissue, and in particular when such locations are provided withenergy directors. At these points the thermoplastic material liquefiesand is pressed into uneven patches and pores (trabecular chambers) ofthe bone tissue; it interpenetrates the bone tissue. Under normalimplantation conditions this interpenetration e.g. in spongeous bonetissue reaches a depth equivalent to about two trabecular chambers.After re-solidification of the thermoplastic material, this material andthe bone tissue are connected to each other in a positive fitconnection, which is e.g. exploited as a primary stabilisation of theimplant immediately after the implantation.

It is found that the thermoplastic material penetrating the bone tissuealso lends the implant a surface structure ideally suited to scatterlight, which is coupled into a proximal face of a transparent implant inaxial direction, from the implant into the bone tissue surrounding theimplant. In its implanted condition the implant represents an excellentlight diffuser. Prior to the implantation, it is a kind of diffuserblank.

The change to the surface caused by the implantation in bone tissue bymechanical vibration, by which a corresponding implant (diffuser blank)becomes a diffuser, develops in the liquid condition of the diffusermaterial, so that the emerging structures have forms created in aflowing motion, therefore induced by a surface tension, and essentiallyrepresenting a negative of the porous bone structure, i.e. in particularcomprising undercuts.

When a laser beam of a 625 nm wavelength is coupled from a lightconductor (diameter 0.4 mm) to the proximal face of a pin-shaped implantof poly-LDL-lactide (length 25 mm, diameter 3.5 mm), ca. 75% of thecoupled light intensity is measured at the distal end of the implant,which represents a very anisotrope light distribution. If the sameimplant is driven into “sawbone” (closed pore polyurethane foamreinforced by glass fibre), whose structure closely resembles bone, byultra-sound and without prior drilling, the implant surface changes andbecomes light scattering. In this state of the implant, an essentiallyequal light intensity is measured (distal end: 0.22 W/mm2;circumferential surface: 0.20 W/mm2) across the implant surface wherealtered by the implantation. These measurements show that the alteredsurface scatters the coupled light very homogenously, i.e. turns theimplant into a very good light diffuser.

The finding described above does not only apply to bone tissue but canbe transferred to other porous materials, in particular to artificialmaterials, wherein such artificial shaping materials are to comprise aporous structure like bone tissue. The pores of such shaping materialare advantageously sized between 0.005 and 1.0 mm. The properties of theshaping material furthermore must be such that its porous structure canoffer sufficient resistance for enabling liquefaction andinterpenetration of the thermoplastic material of the diffuser blankwhen the diffuser blank is introduced in the shaping material bymechanical vibration. If this is not the case, the porous structurecollapses and the interpenetration of the porous shaping materialnecessary for the development of the desired surface structure does nottake place.

Instead of liquefying, by mechanical vibration, a solid diffuser blankmaterial in areas where the diffuser blank is in contact with the porousshaping material, it is also possible to liquefy the diffuser blankmaterial in other ways, e.g. by absorption of electromagnetic radiation(e.g. laser light) at least in the surface regions of the diffuserblank. In both cases, the liquefied material is pressed into the porousshaping material through pressure applied to the diffuser blank.Furthermore, it is possible to press or suck a liquid diffuser materialinto the porous shaping material (e.g. by capillary action or pressuredifference). The liquid diffuser material is then hardened by cooling(e.g. thermoplastic polymers, glasses), by a suitable chemical reaction(e.g. cross-linking resins such as epoxy resin or silicone) or bythickening (e.g. gels or hydrogels on the basis of polyethylene glycols,alginates, chitosanes, collagens and their copolymers or blends). Thismethod not only gives a greater choice of diffuser design than the“implantation method”, but it also makes it possible to create agel-like, i.e. flexible diffuser in a flexible shaping material, whichis then not removed from the diffuser and which is suitable e.g. forillumination of the walls of hollow spaces, as it can adapt to diverseshapes of hollow spaces, or e.g. can even be left in a correspondingspace if a resorbable hydrogel is used. Such a light diffuser can e.g.in the case of tumour excision wounds not only assume the function ofillumination but also the function of wound tamponing after irradiation,to which purpose it is advantageously modified in a known manner withactive substances such as cytotoxins, anti-inflammatory substances,antibiotics or growth factors for the further treatment of the defect.

The properties of an artificial porous shaping material suitable forproducing the diffuser according to the invention can be such that itcan be removed from the diffuser produced therein e.g. by dissolution inan appropriate solvent, by etching, by melting or subliming. Providingthat the shaping material has at least locally suitable properties, itcan also remain on the diffuser surface and form a kind of diffuser cap,which, due to its porosity, can e.g. further scatter light deflected bythe diffuser. Such a diffuser cap of the porous shaping material mayalready have the shape of a cap, i.e. relatively thin walls, when thediffuser is produced, or it may be appropriately processed afterwards.The diffuser cap can also be fashioned for a specific non-opticaladditional function or can be shaped appropriately by a subsequentaddition or removal of material or by re-forming. The porosity of theshaping material can be homogenous. In particular if the diffuser caphas specific non-optical additional functions, it may be advantageous tofashion the porosity inhomogeneous and to vary it depending on thefunction of each part of the diffuser cap. Thus a diffuser cap can beporous where it is to be interpenetrated by a diffuser material whilethe exterior surface of the cap is smooth and free from pores in orderto minimize friction in the tissue and contamination e.g. in theendoscopic application.

Diffusers according to the invention, produced by means of an artificialshaping material, suit non-medical and medical applications, but inparticular the introduction of diffuse light in soft tissue or in tissuevoids (e.g. blood vessels, respiratory passages or digestive tract). Inthat case, the same procedure is followed for the introduction of thediffuse light as with diffusers according to the state of the art,wherein the diffuser according to the invention is coupled with a lightconductor or a light source and is positioned for the application. Thenlight of a desired wavelength is coupled from the light conductor intothe diffuser, which scatters the light and, thus, brings it into thetissue. A particular advantage of flexible diffusers produced by theabove mentioned method is the fact that due to its flexibility, thediffuser can be bent by the operator using per se known cathetertechniques around a large solid angle, such enabling a correspondingcontrol of the instrument on one hand and a targeted illumination on theother.

It is also possible to couple light to be scattered only into a part ofthe diffuser and to equip other areas thereof for other functions,wherein these other areas are e.g. not transparent.

The use of viable tissue, in particular of bone tissue, as porousshaping material for producing the diffuser from a diffuser blank meansthat the diffuser blank is implanted and the light scattering surfacestructures develop during implantation (in situ). It is not imperativeto create an opening (e.g. a bore) in the osseous material prior to theimplantation. E.g. the cortical layer of a bone can be drilled inadvance and the implant positioned in the bore before it is driven bypressure force and simultaneous vibration into the spongiosa, withoutdrilling the latter. With such a diffuser produced in situ, a tumour (ormetastasis) located in the spongiosa can be illuminated in the simplestway. The diffuser implant can remain in the bone tissue for furtherilluminations, where with its intensive anchoring it may represent awelcome further reinforcement of the osseous tissue debilitated by thetumour. The diffuser implant can also consist of a biologicallyresorbable light conducting material so that it does not need to beremoved after its use for the illumination of the tissue and isgradually replaced by regenerated bone tissue.

If the diffuser implant is to remain in the place of implantation afterthe illumination, care must be taken that the proximal end of thediffuser implant does not protrude substantially from the bone and thatits proximal end is primed for the connection with a light conductorwhich is advanced to this proximal end for the illumination as in knownendoscopic methods.

The crucial advantage of the diffuser produced by implantation in viablebone tissue over known diffusers used for the same purpose, is the factthat precursory drilling is not necessarily needed and that the implantdoes not necessarily need to be removed, or to be removed immediatelyafter the application of the diffuser for an illumination or activation.This means that no element needs to be removed from the tissue to betreated before or immediately after the treatment and therefore thedanger of spreading diseased cells, e.g. metastasizing tumorous cells isconsiderably reduced.

BRIEF DESCRIPTION OF THE DRAWINGS

The diffuser according to the invention and the method for itsproduction are described in detail in connection with the followingFigs., wherein:

FIG. 1 shows the method for producing the light diffuser according tothe invention on the example of a diffuser, which is to have amore-or-less cylindrical active range;

FIG. 2 shows a further exemplary diffuser blank and the light diffuseraccording to the invention produced therefrom, which diffuser comprisesa more ball-shaped active range;

FIGS. 3 and 4 show intensity profiles of the light diffusers accordingto FIGS. 1 and 2;

FIGS. 5 and 6 show further exemplary embodiments of diffuser blankssuitable for producing light diffusers with various active ranges;

FIG. 7 shows a further light diffuser according to the inventioncomprising a diffuser core primed for additional functions;

FIGS. 8 and 9 show various ways of coupling light into a light diffuseraccording to FIG. 7;

FIG. 10 shows a further light diffuser according to the invention with ahollow diffuser core primed for further functions;

FIGS. 11 and 12 show diffusers according to the invention with diffusercaps primed for further functions.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates the method according to the invention for producing alight diffuser with the aid of a sequence of sections through thediffuser during production. It shows the production of an exemplarylight diffuser, which is to have a more-or-less cylindrical activerange. As described above, the diffuser can be produced in situ in abone, or ex situ by means of an artificial shaping material, which isinterpenetrated by the diffuser material in a contact layer, wherein forusing the diffuser, the shaping material may be left as a diffuser capon the diffuser or is removed therefrom.

The diffuser blank 1 consisting of a suitably transparent thermoplasticmaterial (in a solid state) has e.g. an essentially cylindrical formwith a distal end 1.1 and a proximal end 1.2, wherein the proximal end1.2 is furnished with a means to couple an appropriately primed distallight conductor end 11, e.g. with a circumferential groove 1.4.

In the illustrated example, essentially the whole circumferentialsurface of the diffuser blank 1, though not its distal face, is to bestructured for the light scattering function. The surface to bestructured, thus, consists of the thermoplastic material and may beadditionally equipped with energy directors, e.g. with a pattern ofhumps or with axially extending ribs (not shown). The surfaces of thediffuser blank 1, which are not to be structured for a light scatteringfunction, are advantageously polished, in particular the proximal faceinto which the light is to be coupled and the distal face which is toreflect light not scattered from the diffuser. On its distal face, thediffuser blank 1 may also comprise an appropriate mirror-like coating.

For producing the light diffuser 10 from the diffuser blank 1, anopening 3 (e.g. a bore) is provided in a porous shaping material 2, theopening being dimensioned, thus that the diffuser blank 1 is at leastlocally slightly larger than the dimensions of the opening. The lengthof the bore is greater than the axial length of that part of thediffuser blank 1 to be positioned in the bore. To prevent the diffuserblank from being brought too far into the bore, the blank comprisesappropriate means, e.g. a proximal collar 1.5.

The diffuser blank 1 is positioned in the bore 3 of the porous shapingmaterial 2 and then pressed into the bore 3, e.g. by means of asonotrode 4 excited by ultrasonic oscillation. The thermoplasticmaterial of the diffuser blank liquefies where it is in contact with theporous shaping material 2, and in particular where energy directors (notshown) of the thermoplastic material are in contact with the porousshaping material 2, which excited by the mechanical vibration causesstress concentrations in the diffuser material. The liquefied diffusermaterial is pressed into the pores of the porous shaping material 2 andinterpenetrates the porous shaping material in a boundary layer 4,advantageously comprising a thickness of ca. 0.02 to 1.0 mm. Therein,the light scattering surface structure 5 is formed on re-solidificationof the diffuser material, as illustrated in detail A, and therewith thediffuser blank 1 becomes a diffuser 10. The produced surface structure 4corresponds essentially with the pore structure of the porous shapingmaterial 2 or a cast negative thereof respectively, i.e. it comprisesforms that are undercut, and, because they were formed in the liquidstate of the diffuser material, induced by a surface tension.

As illustrated on the right hand side of FIG. 1, for its use, thediffuser 10 is supplied with light L by coupling a distal lightconductor end 11 to its proximal end, e.g. by securing an appropriatecoupling piece 12 in the groove 1.4. Such couplings are part of thestate-of-the-art technology and are therefore not further describedhere.

The diffuser 10 can remain in the porous shaping material 2 for itsilluminative function and serve for introducing diffuse light into thisshaping material, e.g. as an illuminative implant in bone tissue, asillustrated at the top right in FIG. 1. The diffuser scatters the lightin a very homogenous manner in a fairly cylindrical active area, asindicated by the chain line 13 (see also FIG. 3).

The porous shaping material 2 (in this case inevitably transparent) can,on the other hand, also form a diffuser cap 14 (FIG. 1, centre right).Such a diffuser cap protects the diffuser and can also be primed e.g.for an additional scattering of the light it receives from the diffuser10 or for further, non-optical functions. The diffuser cap mayfurthermore be primed for further light conducting, distracting,screening, focussing or filtering functions, as known from the state ofthe art. In addition to its optical functions the diffuser cap, if needbe appropriately finished, can represent an instrument or part of aninstrument (see FIGS. 11 and 12).

The porous shaping material 2 may be removed from the diffuser 10 sothat the light scattering surface structure 4 is the only lightscattering means of the diffuser 10 (FIG. 1, bottom right).

For the embodiment of the method according to the invention according toFIG. 1, the diffuser material is selected with regard to the diffuserblank 1, i.e. comprising sufficient mechanical stability to be pressedinto the bore 3. For being as energy-efficient as possible, which, inparticular for an in situ production in viable bone tissue, is alsoprotective, the diffuser material is selected for damping the mechanicalvibration as little as possible (elasticity module greater than 0.5GPa).

Transparent or sufficiently transparently processed thermoplasticdiffuser materials suitable for diffuser blanks to be implanted in bonetissue are e.g. the biologically resorbable polymers based on lacticand/or glycolic acid (PLA, PLLA, PGA, PLGA etc), in particularpoly-LDL-lactide (e.g. available from Böhringer under the trade nameResomer LR708) or poly-DL-lactic acid (e.g. available from Böhringerunder the trade name Resomer R208) or the likewise resorbablepolyhydroxyalkanoates (PHA), polycaprolactones (PCL), polysaccharides,polydioxanons (PD), polyanhydrides, polypeptides or correspondingcopolymers or the non-resorbable polyolefines (e.g. polyethylene),polyacrylates, polymethacrylates, polycarbonates, polyamides,polyesters, polyurethanes, polysulphones, polyphenylsulphides,liquid-crystal-polymers (LCPs), polyacetals, halogenated polymers, inparticular halogenated polyolefines, polyphenylsulphides, polysulphones,polyether or corresponding copolymers and polymer mixtures.

The porous shaping material 2 is selected with regard to its porestructure remaining stable when in contact with the liquefied diffusermaterial but being inter-penetrable by this material. An artificialporous shaping material comprises for the interpenetration suitableporosity, wherein this may be open porosity or closed porosity withpartitions perforable under the circumstances of the method. The poresare advantageously sized between 0.01 and 1.0 mm. Sizes and distributionof the pores may also comprise gradients e.g. for the generation offractal surface geometries or for the production of diffuser caps with asmooth pore-free surface.

Examples of artificial porous shaping materials to remain as diffusercaps on the diffuser and to assume further functions are e.g. glasses(sintered glass, foam glass), amorphous ceramics or ceramics with a highcontent of glass phases (oxidized ceramics such as e.g. aluminium oxideor titanium oxide or non-oxidized ceramics such as e.g. nitrides), dotedceramics (e.g. for further optical-physical functions such as e.g.filtering or stimulation of fluorescence) or amorphous or partlyamorphous thermoplastic or cross-linked polymers. For producing porousforms of said materials, per se known methods are used such as e.g.foaming methods, vacuum-methods, leaching methods, sintering methods orsegregation methods.

If the porous shaping material is to be removed from the diffuser afterits production, it has a lower melting point than the diffuser materialand is removed by heat or it is soluble in a solvent in which thediffuser material is not soluble and is removed by means of a solvent.Further suitable removing methods are etching procedures or sublimationor evaporation techniques. Thus e.g. foamed gypsum used as porousshaping material can be removed from a diffuser of an amorphous polymerby means of a moderate acid (solvent) or a glass with a high content ofsodium (e.g. waterglass) can be removed with water. If the porousshaping material is to be removed from the finished diffuser it may beequipped for further functions not compatible with the diffuserfunction. The shaping material may e.g. comprise a substance capable ofabsorbing electromagnetic radiation (e.g. laser light of a predeterminedwavelength range, e.g. visible or infrared light) at least in the areanear the distal end of the diffuser blank. By coupling correspondingradiation into the trans-parent diffuser blank material, transmitting itthrough the diffuser blank material and absorbing it in the shapingmaterial, heat is produced and the diffuser blank material is liquefiedby this heat in addition to or instead of the heat produced by themechanical vibration.

The diffuser blanks and the diffusers shown in FIG. 1 are of acylindrical shape. Of course this is not a condition for the invention.Similarly, diffuser blanks and diffusers may comprise any chosen crosssection and may e.g. taper towards the distal end either continuously orin steps.

FIG. 2 shows a further diffuser blank 1 and the light diffuser 10produced thereof e.g. in situ in a bone 20 (porous shaping material).The diffuser blank 1 according to FIG. 2 has a distal end 1.1 which ispointed, and only a distal region 30 of its circumferential surface isprovided with protruding energy directors 21 (e.g. axially extendingribs) for producing the light scattering surface structure 4. Theproximal region 31 of the circumferential surface is e.g. polished orcomprises a mirror-like coating.

For the implantation of the diffuser blank 1, a corresponding opening 3is provided e.g. in the cortical layer 20.1 of the bone 20, whichopening is advantageously slightly larger than the cross-section of thediffuser blank. The diffuser blank 1 is then positioned in the openingwith its distal end 1.1 facing forward. The pointed distal end 1.1 ofthe diffuser blank 1 is then driven into the cancellous bone 20.2 bymeans of pressure and mechanical vibration, and the diffuser material isliquefied in the region of the distal end 1.1 and of the circumferentialsurface 30 and is pressed into the porous structure of the spongiosa.Thereby, a diffuser 10 with a distal diffuser part 10.1 and a proximallight conductor part 10.2 is formed.

Obviously, the depth of the diffuser part in the bone is predeterminedby the axial length of the diffuser blank 1 and the axial length of thecircumferential surface region 31 not furnished with energy directors.The shape of the active region of the diffuser 10 according to FIG. 2 isspherical or spherical/cylindrical (chain line 13) depending on theaxial length of the surface region 30 furnished with energy directors21.

Due to its proximal light conducting part, the diffuser blank 1according to FIG. 2 is suitable in particular as an illuminative implantfor the photodynamic treatment of tumours or metastases inside the bone.Therein, the length of the diffuser blank 1 is adjusted to the depth ofthe bone area to be treated, and the length of the surface range 30furnished with energy directors 21 to the size of the bone area to betreated. The diffuser blank 1 is driven from the bone surface into thebone until its distal end is positioned in the bone area to be treatedand the diffuser blank has, thus, become a diffuser. Then, a distallight conductor end or a light source is attached to the proximal end ofthe diffuser and the bone area to be treated is illuminated.

Obviously, for the illumination, there is no need to open up the bonearea to be treated and to bring it into contact with any tool, whichrelevantly reduces the danger of diseased cells spreading from this areacompared to illumination methods according to the state-of-the-arttechnology.

Depending on the diffuser material, it may be adequate not to furnishthe distal area (surface range 30) of a diffuser blank 1′ (in FIG. 2illustrated below the diffuser blank 1) with energy directors 21 but togive it a slightly larger cross-section than the proximal surface range31, so that the surface of the distal range 30 protrudes slightly fromthe surface of the proximal range 31 and, thus, comes into moreintensive contact with the bone tissue 20 in a bore 3 than the furthersurface ranges 31, in which no light scattering surface structure is tobe generated.

As already described in connection with FIG. 1, it is of course alsopossible for the embodiment of the method according to FIG. 2 to use anartificial shaping material and to either leave it on the diffuser as adiffuser cap or to remove it therefrom. The method according to FIG. 2is particularly suitable for the use of a liquid diffuser material. Theliquid diffuser material is pressed or sucked (pressure reduction on theoutside of the form) into a mold, wherein the mold consists of theporous shaping material or comprises an interior coating of the porousshaping material. The diffuser material interpenetrates the porousshaping material in the range of a boundary layer. The liquid diffusermaterial within the form and the named boundary layer is then hardenedthrough e.g. cooling, polymerisation or thickening, thus producing alight diffuser according to the invention, which is further used in themanner described above.

As castable diffuser materials, cross-linkable polymers (e.g.cross-linked chemically, thermally or by radiation), such as e.g.silicones, polyurethanes, epoxy resins or polyester resins can be used.Likewise suitable are thermoplastic polymers, gels (e.g. PEG, PHEMA,acrylates, saccharides, alginates, chitosanes, or copolymers andmixtures of alginates and chitosanes), glasses, glass ceramics or oxidicand non-oxidic ceramics with a high content of amorphous phase. Thecastable material as well as a solid diffuser material may furthercomprise at least one of per se known scattering materials such astitanium oxide, mica, calcium phosphates, sodium phosphates, calciumcarbonates, saturated fatty acids, polysaccharides, glucose etc.Depending on the wavelength of the incident electromagnetic radiationsuch materials may selectively serve as scattering or absorbing agents.This means that for production of a diffuser according to the inventionfrom a solid diffuser blank material containing the named agent(s),corresponding radiation can be coupled into the diffuser blank forproducing heat (instead of or in addition to the heat produced throughthe mechanical vibration) for liquefying the diffuser blank material.

As a removable porous shaping material for producing a diffuser from agelling diffuser material e.g. a Wood's alloy can be used. Such alloyscan be sintered at very low temperatures and after the production of thediffuser they can be removed from the gel at temperatures just a littleabove ambient temperature. Alternatively, the diffuser can be removedfrom the mold by removing the solvent in the gel, i.e. by drying thegel, which reduces its volume.

FIG. 3 shows an intensity profile measured for a diffuser according toFIG. 1. The diffuser was produced by implanting a pin-shaped diffuserblank (length 25 mm, diameter 3.5 mm) of poly-LDL-lactic acid by meansof ultrasound (Branson hand tool, 20 kHZ) in an appropriately predrilledspongeous bone (femur of a sheep). The depth of the bore exceeded 12 mmand the implant was driven into a depth of 12 mm, i.e. not to the bottomof the bore. Then laser light of 625 nm wavelength (power 0.5 W) wascoupled into the implant via a light conducting fibre (diameter 400 μm)through the proximal face and the light intensity was measured by meansof a silicone detector (diameter 7.9 mm) at various points of the bone.

The diagram shown in FIG. 3 shows the measured light intensity [mW]versus the distance from the diffuser surface [mm]. The fit with anexponentially descending curve results in an exponent of circa-−2.2,which suggests a space illuminated by the diffuser with a morecylindrical (theoretical exponent=−2) than spherical (theoreticalexponent=−3) form.

The measured light intensities show, that it is possible to supply abone volume of ca. 1.5 cm diameter with an energy of 10 J, which issufficient for a cytotoxic photodynamic therapy treatment, with the aidof an implant of 3.5 mm diameter and a ca. 15 min. radiation time.

FIG. 4 shows an intensity profile measured on a diffuser according toFIG. 2. The diffuser was produced by pressing a pin-shaped diffuserblank (length 25 mm, diameter 3.5 mm) of poly-LDL-lactic acid usingultrasound (Branson hand tool, 20 kHZ) without pre-drilling into a pieceof “sawbone” (glass fibre reinforced polyurethane foam) to a depth of 12mm. Then, laser light of 625 nm wavelength (power 0.5 μW) was coupledfrom a light conducting fibre (diameter 400 μm) through the proximalface into the implant and the light intensity was measured by means of afibre-detector (diameter 200 μm) at various points in the piece ofsawbone.

The diagram shown in FIG. 4 shows the measured light intensity [counts]versus the distance from the diffuser surface [mm]. The fit with anexponentially descending curve with an exponent of −3 is good (r=0.89)and indicates an essentially spherical form of the space illuminated bythe diffuser.

FIGS. 5 and 6 show two further exemplary diffuser blanks 1, from whichdiffusers for various applications can be produced by the methodaccording to the invention. The diffuser blank 1 according to FIG. 5comprises a pointed distal end 1.1 and the distal region of itscircumferential surface is furnished with energy directors 21 (e.g.axially extending ribs) around half the circumference, so that a lightscattering structure can be generated only in this surface range. Such adiffuser blank results in a diffuser with an active area comprisingroughly the shape of a hemisphere. The diffuser blank 1 according toFIG. 6 comprises a blunt distal end 1.1 and a middle region of itscircumferential surface is furnished with energy directors 21 (e.g.humps) halfway around the circumference. Using the method illustrated inFIG. 1, this diffuser blank produces a diffuser with an active arearoughly equivalent to half a circular cylinder.

Diffusers with active areas of most diverse shapes can be designed fromdiffuser blanks like those illustrated in the FIGS. 5 and 6. Therein thediffuser blanks do not necessarily need to be pin-shaped and to comprisecircular cross-sections as illustrated. They can also have a morecompact form, be conically shaped and/or comprise polygon or irregularcross-sections.

FIG. 7 is an axial section of another diffuser 10 according to theinvention comprising a diffuser core 40, wherein the diffuser core 40 isequipped for further, e.g. non-optical functions. The diffuser material(e.g. polymerpine) bearing the light scattering surface structure isarranged on the diffuser core 40 periphery and covers the surface of thediffuser core 40 completely or partially. The diffuser core 40 consistse.g. of titanium and in a diffuser implant assumes e.g. a load bearingfunction. The diffuser can be produced in situ or ex situ from acorresponding diffuser blank.

Light is to be coupled into the diffuser 10 according to FIG. 7, onlythrough a part of the proximal face (outer ring). To this end e.g. alight conductor 11 is used as illustrated in cross-section in FIG. 8.This light conductor 11 comprises a conductor core 41 and lightconducting fibres 42 arranged around it, wherein the cross-section ofthe conductor core 41 is adjusted to the proximal face of the diffusercore 40.

The diffuser core 40 can assume further functions instead of, or inaddition to the already mentioned load bearing function and for suchpurposes consist of an appropriate material. If the diffuser is producedex situ, such an additional function serves e.g. for controlling themovement of the diffuser on positioning it at a location to beilluminated. If the diffuser or the diffuser cap is fashioned as aninstrument (see FIGS. 11 and 12), the additional function can further bea rinsing or suction function for which the diffuser core is designed asa hollow conduct. Further light conductors may extend into such a hollowconduct of a diffuser produced e.g. in situ, wherein the further lightconductors have e.g. a recording function and are connected to amicro-camera, which may serve e.g. the simultaneous analysis of anillumination effect or to detect and locate tumorous cells marked byfluorescence.

The diffuser core 40 of a diffuser produced in situ (diffuser implant)may also have a release function in order to administer a drug to thetissue surrounding the diffuser. If resorbable polymers or gels are usedas diffuser material, this release function can also be performeddirectly via the diffuser material. The diffuser core can also befashioned as an optical element separated from the diffuser and designedfor the coupling of light of another wavelength (e.g. in order toactivate another photosensitive drug) or for the coupling of infra-redlight in order to warm the tissue surrounding the diffuser. Thearrangement of the diffuser material on the diffuser core 40 is to beadapted to the function of the diffuser core 40.

FIG. 9 is an axial section through a further diffuser according to theinvention, which can be produced in situ or ex situ and which comprisesa diffuser core 40, upon which the diffuser material is arranged e.g. asa coating. For being coupled to the light conductor 11, the diffusercore 40 comprises a proximal region with a central opening 43, whereine.g. at the bottom of the opening a conical mirror surface 50 isarranged and light emission apertures 51 are arranged above the mirrorsurface. A distal end of a light conductor 11 (without cladding and withits front face advantageously adapted to the mirror surface 50) isintroduced into this opening for coupling light into the central opening43. The light introduced by the light conductor 11 is reflected from themirror surface 50 and reaches the diffuser material through the lightemission apertures 51, as indicated in FIG. 9 by arrows.

FIG. 10 is an axial section through a further diffuser 10 according tothe invention with a diffuser core 40, which diffuser too can beproduced either in situ or ex situ. The diffuser core 40 issheath-shaped and comprises through openings. The diffuser material,e.g. a thermoplastic polymer, gel or thermosetting polymer, is providedin the diffuser blank inside the sheath-shaped diffuser core 40. Thediffuser 10 is produced by the diffuser material being pressed with theaid of mechanical vibrations deeper into the diffuser core, through theopenings and into the surrounding bone tissue or artificial porousshaping material, and thereby gains the light scattering surfacestructure 5.

FIGS. 11 and 12 show diffusers 10 according to the invention, which areproduced ex situ and comprise a diffuser cap 14 constituting aninstrument or a part of an instrument. The instrument illustrated inFIG. 11 is a scalpel shown in axial section, whose blade is the diffusercap 12, i.e. contains a diffuser 10 according to the invention. Thediffuser cap consists e.g. of a transparent ceramic material, which isadvantageously only relevantly porous in those areas where it is toserve as a porous shaping material, while it is, in particular in thearea of the cutting edge, as compact as possible. A coupling point for alight conductor (not shown) is situated in the region of the handle 60.Due to the coupling of light into the diffuser 10, the scalpel bladebecomes luminous and can illuminate homogenously its own working area.

The scalpel blade according to FIG. 11 is produced e.g. by a liquiddiffuser material being sucked into an appropriate bore in the blade orbeing introduced by any of the other aforementioned methods. The bladecan be further adapted after the diffuser 10 has been produced. Toprevent the diffuser material from gaining a light scattering surface inthe region of the handle 60, no porous shaping material, but a compactshaping material is to be provided there.

It is also possible however, to provide a slightly larger bore in theregion of the handle 60 than in the region of the blade and to introducethe diffuser material in the shape of a pin into the handle and to pressit further into the blade with ultrasound and to transfer the light viathe handle functioning as a light conductor into the blade.

FIG. 12 shows, as a further example of a diffuser 10 according to theinvention with a diffuser cap 14, an instrument similar to a pair ofscissors or nippers, whose blades or legs 70 and 71 are each equippedwith a diffuser (schematically indicated by broken line) in the mannerdescribed with regard to the scalpel blade of FIG. 11. When theinstrument is in use, the blades or legs 70 and 71 serve simultaneouslyas a source of diffuse light, which illuminates the working area of theinstrument.

Obviously, instruments or parts of an instrument equipped with adiffuser as illustrated in FIGS. 11 and 12 can also be equipped withdiffusers as known from the state of the art. In other words, it is nota condition for such instruments, that their diffusers have a lightscattering surface, which is induced by surface tension and whichcomprises undercut forms. Other known light scattering surfacestructures can be created by casting in non-porous structures or bycorresponding machining of a diffuser blank before it is positioned inthe diffuser cap.

The described diffusers, which can be produced by the illustrated methodfrom the described diffuser blanks, are used e.g. for photodynamictherapy methods, in particular for the treatment of tumorigenicdiseases. For such application, in the method for introducing diffuselight into a tissue region as herein described and claimed, in whichmethod one of the herein described and claimed, in particular pin-shapeddiffuser blanks is implanted in the tissue, the tissue in question ise.g. a bone tissue and the bone tissue region to be treated is theregion of a bone tumour or a metastasis.

The photodynamic therapy method thus comprises the steps of: introducinga photosensitive substance into the tumorous tissue or the metastasis,producing a diffuser according to one of the embodiments of the methodhere described and claimed (in situ) or introducing a diffuser producedex situ into the tumorous tissue or the metastasis, illuminating thetumorous tissue or the metastasis through the diffuser, in particularwith a specific wavelength activating the photosensitive substance, andthus triggering a chemical reaction, by which the tumorous cells or themetastasis are destroyed. The method steps of “introducing thesubstance” and of “producing the diffuser” may also take place inreverse order. The illumination does not need to be performed with lightin a visible range of wavelengths, the term “illuminate” alsoincorporates radiation with electromagnetic radiation of otherwavelengths, in particular in the range of infrared or ultraviolet.

The step of introducing the photosensitive substance can be carried outby systemic administration of a substance which principally gathers inthe tumorous tissue or the metastasis. The substance may also beadministered locally to the tumorous tissue or the metastasis.Furthermore, it is possible to release the substance through thediffuser or the diffuser blank.

The invention claimed is:
 1. A light diffuser consisting of an at leastpartly transparent diffuser material, the light diffuser comprising: aproximal end suitable for coupling light supplied by a light conductorinto the light diffuser, and the light diffuser further comprising lightscattering surface areas through which the light coupled into the lightdiffuser is deflected diffusely out of the light diffuser, wherein thelight scattering surface areas comprise structures which are produced byinterpenetration of the diffuser material in a liquid state in aboundary layer of a porous shaping material, which structures aretherefore induced by a surface tension and are undercut in relation tothe porous shaping material.
 2. The light diffuser according to claim 1,being pin-shaped and the light scattering surface areas being situatedupon its circumferential surface and/or at its distal end.
 3. The lightdiffuser according to claim 1, wherein the diffuser material is athermoplastic material, a material which is thermosetting through achemical reaction, or a gel.
 4. The light diffuser according to claim 1,and further comprising a diffuser core equipped for at least one of aload bearing function, a movement controlling and positioning function arinsing function, a section function, a recording function.
 5. The lightdiffuser according to claim 4, wherein the diffuser core consists of anon-transparent material and is equipped for a load bearing function. 6.The light diffuser according to claim 4, wherein the diffuser coreconsists at least partly of a transparent material.
 7. The lightdiffuser according to claim 1, and further comprising a diffuser cap ofthe porous shaping material, wherein the porous shaping material of thediffuser cap is interpenetrated in a boundary layer by the diffusermaterial.
 8. The light diffuser according to claim 7, wherein thediffuser cap is designed as cutting instrument or part of a cuttinginstrument, or a nipper or a part of a nipper.
 9. The light diffuseraccording to claim 7, wherein the diffuser cap comprises anon-homogenous porosity.
 10. A method for producing a light diffuser,the method comprising the steps of: pressing a diffuser material, in aliquid state, into pores of a boundary region of a porous shapingmaterial and then bringing it into a solid or gel-like state wherein thediffuser includes: a proximal end suitable for coupling light suppliedby a light conductor into the light diffuser, and light scatteringsurface areas through which the light coupled into the light diffuser isdeflected diffusely out of the light diffuser, wherein the lightscattering surface areas comprise structures which are produced duringthe interpenetration of the diffuser material in a liquid state in theboundary region of the porous shaping material, which structures aretherefore induced by a surface tension and are undercut in relation tothe porous shaping material.
 11. The method according to claim 10,wherein the porous shaping material is left on the diffuser as adiffuser cap.
 12. The method according to claim 10, wherein the porousshaping material is removed from the diffuser.
 13. The method accordingto claim 10, wherein the porous shaping material comprises a porositywith a pore size ranging between 0.005 and 1.0 mm.
 14. The methodaccording to claim 10, wherein a diffuser blank consisting of athermoplastic diffuser material and comprising a distal end and aproximal end, which is equipped for coupling the supplied light into thelight diffuser, is positioned in or on the porous shaping material andthat mechanical vibration is applied to the proximal end and thediffuser blank is simultaneously pressed against the porous shapingmaterial, so that the thermoplastic diffuser material liquefies in thoseregions of the surface area in contact with the porous shaping materialand is pressed into the porous shaping material.
 15. The methodaccording to claim 10, wherein a diffuser blank consisting of athermoplastic diffuser material and comprising a distal end and aproximal end, which is equipped for coupling the supplied light into thelight diffuser, is positioned in or on the porous shaping material,wherein the diffuser material and/or the shaping material are equippedfor absorbing light coupled into the diffuser material, and that lightis coupled into the proximal end, and the diffuser blank issimultaneously pressed against the porous shaping material, so that thethermoplastic diffuser material liquefies at least partly through heatproduced by the light absorption and is pressed into the porous shapingmaterial.
 16. The method according to claim 14, wherein an opening isprovided in the porous shaping material and wherein the diffuser blankis positioned in the opening such that its distal end is not brought incontact with the bottom of the opening, neither when it is positionednor when it is pressed and the mechanical vibration is applied.
 17. Themethod according to claim 14, wherein an opening is provided in theporous shaping material and the diffuser blank is driven into a bottomof the opening, the distal end facing forward or wherein no opening isprovided in the porous shaping material and the diffuser blank is driveninto the porous shaping material with the distal end facing forward. 18.A method for introducing diffuse light into an area in a tissue to betreated with light, which is supplied to the tissue area by means of alight conductor with a distal light conductor end, the method ofintroducing comprising the steps of: implanting a diffuser blank, thatcomprises thermoplastic diffuser material and includes a proximal end,in the tissue such that its proximal end remains accessible and a distalend reaches to, or into the tissue area to be treated, wherein, forimplantation, mechanical vibrations are applied to the diffuser blankthrough its proximal end and the diffuser blank is pressed into thetissue such that the thermoplastic diffuser material is liquefied insurface areas protruding or equipped with energy directors and ispressed into the tissue, the tissue thereby functioning as porousshaping material, whereby the diffuser blank is deformed into a diffusercomprising a proximal end, the proximal end being suitable for couplinglight supplied by a light conductor into the light diffuser, and lightscattering surface areas through which the light coupled into the lightdiffuser is deflected diffusely out of the light diffuser, wherein thelight scattering surface areas comprise structures which are producedduring the interpenetration of the diffuser material in a liquid statein a boundary region of the tissue, which structures are thereforeinduced by a surface tension and are undercut in relation to the tissue,and, and wherein the distal light conductor end is then coupled to theproximal end and light is coupled into the diffuser.
 19. The methodaccording to claim 18, wherein the diffuser blank is pin-shaped and isimplanted in bone tissue.
 20. The method according to claim 18, whereina cortical bone layer is opened for the implantation of the diffuserblank, and wherein the diffuser blank is driven into cancellous bonewithout providing an opening therein.
 21. The method according to claim18, wherein the diffuser blank comprises towards its proximal end asurface range without energy directors or with a recessed surface andthat the axial length of this surface range is adjusted to the depth ofa bone region to be treated.
 22. The method according to claim 20,wherein the diffuser blank comprises towards its distal end a surfacerange with energy directors or with a protruding surface and that theaxial length of this surface range is adjusted to the size of the bonetissue area to be treated.
 23. A method for introducing diffuse lightinto an area in a tissue to be treated, comprising the steps of:supplying light to the tissue area by means of a light conductor with adistal light conductor end, implanting a diffuser blank comprising athermoplastic material and a light-scattering/light-absorbing agent inthe tissue such that its proximal end remains accessible and its distalend reaches to, or into the tissue area to be treated, for implantation,coupling light which is predominantly absorbed by thelight-scattering/light-absorbing agent into the diffuser blank throughits proximal end and pressing the diffuser blank into the tissue suchthat the thermoplastic diffuser material is liquefied at least partlyand is pressed into the tissue, whereby the diffuser blank is deformedinto a diffuser comprising a proximal end, the proximal end beingsuitable for coupling light supplied by a light conductor into the lightdiffuser, and light scattering surface areas through which the lightcoupled into the light diffuser is deflected diffusely out of the lightdiffuser, wherein the light scattering surface areas comprise structureswhich are produced during the interpenetration of the diffuser materialin a liquid state in a boundary region of the tissue, which structuresare therefore induced by a surface tension and are undercut in relationto the tissue, and wherein light, which is predominantly scattered bythe light-scattering/light-absorbing agent is then coupled into thediffuser.
 24. A set of parts comprising a light diffuser according toclaim 1, and further comprising a light conductor or light sourcecoupled to the proximal end of the light diffusor or equipped for beingcoupled to the proximal end of the light diffusor.
 25. An arrangementcomprising: bone tissue; and a light diffuser implanted in the bonetissue, the light diffuser comprising: an at least partly transparentdiffuser material; a proximal end suitable for coupling light suppliedby a light conductor into the light diffuser; and light scatteringsurface areas through which the light coupled into the light diffuser isdeflected diffusely out of the light diffuser; wherein the lightscattering surface areas comprise structures which are produced byinterpenetration of the diffuser material in a liquid state in aboundary layer of the bone tissue and which structures are thereforinduced by a surface tension and are undercut in relation to the bonetissue.